title: Empiric antibiotic treatment of erythema migrans-like skin lesions as a function of geography: a clinical and cost effectiveness modeling study.
abstract: The skin lesion of early Lyme disease, erythema migrans (EM), is so characteristic that routine practice is to treat all such patients with antibiotics. Because other skin lesions may resemble EM, it is not known whether presumptive treatment of EM is appropriate in regions where Lyme disease is rare. We constructed a decision model to compare the cost and clinical effectiveness of three strategies for the management of EM: Treat All, Observe, and Serology as a function of the probability that an EM-like lesion is Lyme disease. Treat All was found to be the preferred strategy in regions that are endemic for Lyme disease. Where Lyme disease is rare, Observe is the preferred strategy, as presumptive treatment would be expected to produce excessive harm and increased costs. Where Lyme disease is rare, clinicians and public health officials should consider observing patients with EM-like lesions who lack travel to Lyme disease-endemic areas.
authors.affiliation: 1 Department of Medicine, Duke University School of Medicine , Durham, North Carolina.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Lantos
authors.forename: R Jory
authors.initials: RJ
authors.lastname: Brinkerhoff
authors.forename: Gary P
authors.initials: GP
authors.lastname: Wormser
authors.forename: Robert
authors.initials: R
authors.lastname: Clemen
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001096:Arachnid Vectors / Q000502:physiology; D025065:Borrelia burgdorferi / Q000302:isolation & purification*; D003362:Cost-Benefit Analysis; D003657:Decision Making; D003661:Decision Support Techniques; D015787:Erythema Chronicum Migrans / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control; D005843:Geography; D006801:Humans; D018884:Ixodes / Q000502:physiology; D026863:Ixodidae / Q000502:physiology; D012867:Skin / Q000473:pathology; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents